Abstract

PIP: This article discusses deficits in postpartum and postabortion care for women in developing countries. Postpartum and postabortion care frequently does not include family planning counseling. The risk of poorly timed or unwanted pregnancies is increased with a woman's inability to obtain effective contraception. Family planning programs must now address unmet need for contraception in postpartum and postabortion services, especially among rural women and adolescents. Programs need to focus on comprehensive reproductive health care. Women who deliver in medical settings may not receive contraceptive counseling after a delivery. A return to the hospital may not occur unless there are complications. Traditional birth attendants should be included in programs that provide postpartum care. Notwithstanding the lack of postpartum programs in many health settings, there are also constraints to reproductive health care in postpartum and postabortion family planning services. Sometimes family planning lacks institutional support and is poorly integrated into postpartum programs. Cultural barriers, provider biases, a lack of adequately trained personnel, legal barriers, and inadequate client-centered services interfere with delivery of family planning. Natural family planning methods are not always included in family planning services, even when culturally appropriate. The 1990 International Conference on Postpartum Contraception in Mexico and the 1993 International Workshop on Postpartum and Postabortion Family Planning in Ecuador made recommendations for improving postpartum family planning. Two key steps to improved services include training providers to counsel clients effectively and training program managers to adopt more gender-sensitive approaches to service delivery. Institutional and community support should be built on identifying needs and opportunities.